Risk Factors for Acute Symptomatic Coccidioidomycosis among Elderly Persons in Arizona, 1996–1997

Abstract

Because of the increase in incidence of coccidioidomycosis among the elderly in Arizona between 1990 and 1996, a case-control study was conducted to look at risk factors for disease among these persons. Cases (n=89) were persons aged > or =60 years with laboratory-confirmed coccidioidomycosis; 2 control groups were selected, the first by use of random-digit dialing (geographic controls, n=91) and the second by use of lists of persons with negative serologic coccidioidomycosis tests (laboratory-negative controls, n=58). Elderly persons with coccidioidomycosis had spent significantly less time in Arizona than did persons in either control group and were more likely than geographic controls to have congestive heart failure or cancer, to have smoked, or to have taken corticosteroids. Elderly persons who recently have moved to Arizona or who have chronic illnesses and their physicians need to be aware of their higher risk for coccidioidomycosis in order to improve their chances of early diagnosis and treatment. These persons may benefit from vaccination, once an effective vaccine for coccidioidomycosis is developed.

In Vitro Whole-Blood Analysis of Cellular Immunity in Patients with Active Coccidioidomycosis by Using the Antigen Preparation T27K

“…The average age of the patients with active coccidioidomycosis was nearly 67 years. While this appears old, recent data indicate that symptomatic coccidioidomycosis is far more prevalent among those aged 60 years and over than among younger subjects (4,21). Because all patients with active coccidioidomycosis at the medical center were referred to the coccidioidomycosis clinic and were eligible for study, the older age most likely reflects the predisposition for symptomatic illness among an older age group rather than any other factor.…”

Diagnosis and Initial Management of Musculoskeletal Coccidioidomycosis in Children

“…In Arizona, while coccidioidomycosis is more likely to be reported in persons older than 60 years 45 , the incidence in patients younger than 20 years increased 121% from 1998 to 2001, a larger increase than in any other age group in that period 6 . A study in the American Indian population reported increased susceptibility to coccidioidal dissemination in children younger than 5 years old as compared to other age groups 46 .…”

Update on the Epidemiology of Coccidioidomycosis

“…Age is one such aspect that has been identified. In Arizona, those greater than 65 years of age were found to have the highest incidence of infection [22]. Although this finding has not been fully evaluated given that much of the elderly population of Arizona is comprised of individuals who have relocated from non-endemic areas either on a seasonal or permanent basis.…”

“…Although this finding has not been fully evaluated given that much of the elderly population of Arizona is comprised of individuals who have relocated from non-endemic areas either on a seasonal or permanent basis. Another case-control study of geographically matched controls revealed that each year lived in Arizona provided a 5 % decline in the risk for acquiring coccidioidomycosis [22]. The impact of the large influx of elderly individuals to Arizona from non-endemic areas may explain their disproportionate burden of disease given that the incidence of infection within California peaks between 40 and 49 years of age [23].…”